While elevated PSA’s don’t strike quite the fear they did a few years ago with life insurance underwriters, there is still concern when a PSA gets above the normal limit of 4 and remains there or continues to rise. There is finally a consensus in the medical community that an elevated PSA isn’t always related to prostate cancer. In fact there is growing concern among urologists that there are too many biopsies, an invasive procedure, occurring when they don’t need to be.
The concern for and, practically, the need for a core biopsy comes when the PSA is rising fairly quickly or has gone above normal. Either of those in combination with a questionable digital rectal exam (DRE), that gives the impression of an abnormality in the prostate is definitely a reason for a baseline core biopsy. If negative the whole situation of the elevated PSA may be attributed to BPH or possibly an infection of the prostate, both easily treated and certainly not uncommon in us older guys. If positive, but a low grade prostate cancer, watchful waiting (just keeping track of the PSA and how it acts, may be the most prudent course of action. It isn’t uncommon for a man to have prostate cancer for the rest of their life and not die from it or anything related to it.
So how do life insurance underwriters wrap their heads around all of the variables of normal and above normal PSA’s, biopsies or not, watchful waiting, prostate cancer and the like? Almost all underwriters want to see at least a baseline biopsy if the PSA goes above normal. If it goes up in the 5 to 7 range, but fluctuates up and down, the life insurance underwriter may eventually just attribute it to chronic elevation due to benign prostatic hypertrophy or a chronic infection and allow the life insurance to be approved. Generally they have a caveat that the PSA has never been above 10. Even with a negative biopsy they may want the client to be monitored for a few more checkups before buying that it is due to something other than cancer for life insurance purposes.
With low grade, Gleason 3+3=6 prostate cancer, with time and a few biopsies a very few life insurance companies will accept watchful waiting as acceptable if the men are in the 60 to 70 year old range. With cancer that is treated, whether with a prostatectomy or radiation seed implant, life insurance can be approved as soon as the PSA is 0 with the prostatectomy or .5 or under with see implant therapy.
Bottom line. With the right impaired risk life insurance agent using the right company, in the absence of high grade prostate cancer, coverage is available. If you have questions or have been denied life insurance in one of the areas covered above, call or email me directly. My name is Ed Hinerman. Let’s talk.